### TRANSMITTA Lo f OMAH A LEA D SIT E SOI LREMEDIATIO NFIL EFOLDE R
SAID# : .^4 n Date : ^\QQ>llf \ Address : l^-^Jj A lOi ^" ^ S f Remediatio nContractor : Coasta l Environmenta l Group

_Year : _2008
_ SOI LREMEDIATIO N PROPERT Y FIL EFOLDE RDOCUMENT S ^ mVide o o f property (DVD ) ^"""^ ^ \J(ULaJ r [e l B ^ Executiv e Summar y B ^ EPA-provide dpropert y sketc h4031478 0 H ^ Signe dAcces s Agreemen t fo r subjec t propert y ||||| | |||||||||||||||||||i | |||||| | MIL . Superfun d tp V Signe dAcces s Agreement(s ) fo r adjacent property B ^ Restoratio nAgreemen t |6^ nSettlemen t document s (i.e. , fo r damag e or to replac e plants , etc. ) 5K Confirmatio ndat a B ^ Photograph s pre . - 6 ^/Jc;i l O AQJCC^sJoJl^Q^ ^ yli^a A Sdc i c

/ As-buil t sketc h S /

Satisfactory restoratio nsigne db y Property Owne r H

^ Property close-ou t chec k lis t signe db y EP A |^l \Descriptio no f area s no t meetin g RO D cleanu p criteri a WUtility clearance s ^ 

### Property informatio nfro mDougla s County Assessor' s Offic e 

# r

I^Qor La.cULg-s< : nAeJcJi^- r ^ (1^/2/ ^ i^ m D

# m Propert yAcces s Checklis t Propert y ID : 3§m\ nWOR K STARTE D ON : / / 1 Propert y Address : M ^i^ q^ 2M ^ 3 nWORKCOIMPELTE D ON : / / Ownc i Renter : Address : Phone : Fa.\ : Cell/Pager : 

# '''"""(303)^i(o-4(D^ l Fax : Additiona l Information : Cell/Pa,er^ge^^> ) 31-1-\1X ? 1 O Notificatio nLette r Sent : / / By : Q * Acces s Agreemen t Signed : ^/JO/ ^ 

## By-f r Q ' Restoratio nAj^reement Signed : ^/i^/OS ' 

## B.v^e C 1 nTop.soil Samplini ; (i f applicable ) / / By : O Disposal Samplin g (if applicable ) / / By : 1 1 Garde nSamplin g (if a|)|)licable ) / / By : ' ^ Ltilit v Clearanc e Called : _g_/10/C ^ 

## ^y(\'n'0 % JZ ^ Video/Photo s (Before ) 

## On:_l//5_ / 6 ^ B>
- i^trvdifl s nVideo/Photo. s (During ) On : / / By : |" D Video/Photo s (After ) On : / / By : D Video/Photo s (30-Day ) On : / / By : n nPropert y Completio nAgreemen t Signed : / / By : c nFina l Repor t I.s.sued : / / By : Ai r Monitorin g (a s applicabl e )
• Communit y • Cre w On : / / 

### By : 1 Results : I 1 nCommunit y O Cre w On : / / 

### By : _1 Results : 1 c nCommunit y Cll'Cre w On : / / By : Results :
Omah a Lea d Sit e

## CONTACT FOR M Propert y ID # Propert y Address : Initia l Contact : Secon dContact : Fina l Contact : Fina l Action :

Comment : Owne r Commen t (s) : Sit e Coordinato r Commen t (s) : 

# .^5Hl \ 

# 4lli M U a ^ 3 4 Date : Time : Action : Date : Time : Action : Date : Time : Action : Transmi t t o EP A D Othe r Action : D

# VS , 

# FA X

T

O Chapma n Mitti s L FROM : Elizabet h Cacere s FAX: (303 ) 371-122 8 FAX: 87 7 66 2 421 1 Tol l Fre e PHONE : (303 ) 916-464 1 PHONE : (402 ) 504-219 4 SUBJECT : Acces s an d Restoratio n Agreement s DATE : Septembe r9 , 200 8 COMMENTS: Pleas e complete , sign , dat e an d fa xbac k t o ou rtol l Fre e Fa x877-662-4211
. Than k You , Elizabet h Cacere s

### Dougla s County Accoun t Informatio n Pag e 1 of 2 Dougla s County , Nebrask a Propert yRecor d - R020402000 0 Prin t Repor t NE W Featur e - Parce l Dimension s availabl e @ scal e 0-5 0 ft wes t of 90t h S t - Viewo n Ma p Informatio n i s vali d a s of 2008-9- 4 Treasurer' s Ta xRepor t Ne wFeatur e ->->- > Aut o Sale s Searc h Owne r CHAPMA N MlTTl S L 2145 3 E 5 4 PLZ DENVE R C O 80249-000 0 Propert yInformatio n Ke yNumber : 040 2 000 0 0 2 Accoun t Type : Residentia l Parce l Number : 020402000 0 Parce l Address : 476 4 N 2 4 S T OMAH AN E 68110-000 0 Lega l Description : LAND S SEC-TWN-RG E 04-15-1 3 S 1/ 2 SU B 2 & N 4 5 FTSU B 3 L T1 1 67. 5 X 13 2 Valu e Informatio n 200 8 200 7 200 6 200 5 200 4 200 3 Lan d $600.0 0 $600.0 0 $600.0 0 $600.0 0 $600.0 0 $600.0 0 Improvemen t $0.0 0 $0.0 0 $0.0 0 $0.0 0 $0.0 0 $0.0 0 Tota l $600.0 0 $600.0 0 $600.0 0 $600.0 0 $600.0 0 $600.0 0 Sale s Informatio n Sale s Date : 2006-11-1 5 Dee d Type : 

### Price : Q C $1.0 0 Book : 200 7 Page : 04860 6 Grantor : Colorad o Classi cPropertie s Grantee : Chapma n Mitti s L Valid/Invalid : Invali d Exclusio n Reason : Sale s Date : 2001-04-1 1 Dee d Type : SH D Book : 200 3 Page : 17170 5 Price : $392.0 0 Grantor : SHERIF F 

### http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=R020. . . 9/9/200 8

### Dougla s County Accoimt Informatio n Pag e 2 of 2
Grantee : COLORAD O CLASSI C PROPERTIE S Valid/Invalid : Invali d Exclusio n Reason : Sal e b yGovt Agency Lan d Informatio n Acre s S F Unit s Dept h Widt h Vacan t 0. 2 8976. 0 0. 0 132. 0 68. 0 Ye s



### http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=R020. . . 9/9/200 8

### Pag e 1 of 2

Creat e Anothe rTicke t Bac k t o Irt h Interne t Sen d Emai l


### YOU RTICKE T NUMBE RI S 2128551 . Origina l Cal l Date : 9/10/0 8 Time : 5:0 4 p m Op : ELIZABETH1879 0 Wor k t o Begi n Date : 9/12/0 8 Time : 5:3 0 p m State : N E County : DOUGLA S Place : OMAH A Address : 476 4 Street : N24T H S T Twp : 15 NRng : 13 E Sect-Qtr : 03-NW,04-N E Twp : Rng : Sect-Qtr : Lega l Given : C Typ e o f Work : lea d remidiatio n Locatio n o f Work : LOCAT E ENTIR E PROPERT Y AL L TH E WA Y T O TH E STREE T AN D TH E : HOUSE . Remarks : FAX AL L CLEAR S TO : (877)662-421 1 : UNSUR E O F CORNE R LO T Compan y: COASTA L ENVIRONMENTA L SERVIC E Contac t Name : ELIZABET H Phone : (877)662-421 0 Wor k Bein g Don e For : coasta l Dept h o f Excavation : 4f t Come r Lot : N Front : Y Rear : Y Involve s Tunnelin g o r Horizonta l Borin g : N Explosives : N CXCAT V MAGELLAN MUDO l OMAHACO F 0PPDGPR 5 QLNNEI C SPRNTPC S

Servic e Are a Contac t Phon e Numbe r UtiUt y Typ e 

### Day : 402934046 9 CXCAT V CO X COMMUNICATIONS , IN C 

### HEID I Alt : 402934046 9 Emerg : 402932975 7 Day : 918574709 8 MAGELLA NMAGELLA NMIDSTREA M PARTNER S L PTONY A Alt : 

### Emerg : 918574709 8 Day : 402504782 3 MUDO l METROPOLITA NUTILITIE S DISTRIC T SAND Y Alt : 

### Emerg : 402504794 6 Day : 402444719 7 OMAHACO FCIT Y O FOMAHA-TRAFFIC,SEWE R 

### RO NAlt : 402444516 1 Emerg : 402444516 0
http://www.dhon.org/irthintemet/DHONNoticeCreation/MessageText.asp?ret=<RESULTS. . . 9/10/200 8

### Pag e 2 of 2 Day : 406728934 3 OPPDGPR 5 OMAH A PUBLI C POWE RDISTRIC T 

### N A Alt : 888728934 3 Emerg : 406728934 3 Day : 406728934 3 QLNN E1 C QWES T LOCA LNETWOR K 

### N A Alt : Emerg : 888728934 3 Day : 402537180 0 SPRNTPC S SPRIN T SPECTRU M LP 

### Alt : 402537181 0 Emerg : 800521057 9

http://www.dhon.org/irthintemet/DHONNoticeCreation/MessageText.asp?ret=<RESULTS. . . 9/10/200 8

### 3541 1 

# As-Buil t Drawin g COASTA L 

# Omah aLea dSuperfun dSit e

Exterio rPain l Nort ^ Arro w Omah a Lea d Sit e Owne rName : COLORAD O CLASSI C PRO P • Good Sit e Sketc h Address : 476 4 N24S T • Poo r

Phone : H : W
. 0 * No t pain t Lea d Sampl e Sample s Collecte d Sampl e Numbe r LA B Concentratio n Collecte d Firm : /^sw l p-s i AJ " RYASCPXA-3541 1 F 1 

## J^i
. pp m 

### 0' D Date ; ii - IS - og- . RYBSCPXA-3541 1 F 2 

### I S pp m 

### D Time : i n •.3>o Sr ^ RYCSCPXA-3541 1 B l 

## -Sl l pp m 

### D Sample s Analyze d RYDSCPXA-3541 1 8 2 pp m RDZSCPX A3M1 1 Bi r 

## ±±5 - pp m 

### D 

# n XR F Unit : /OCT ? Book:/7 ^ nCZGCPX A3541 1 S * pp m 

### D D Date : /2 - / 2 - OC s nPZSCPX A3641 1 P i pp m 

### D D Time : Ar> ^ 

### D Staff : /^ii ^ Numbe ro f Sample s = ^ Legend : F l = Fron t Left , F 2 • Fron t Right , B l = Bac k Left , B 2 = Bac k Righ t D Z = Dri p Zone , G Z = Garden , P Z = Pla y Al l quadrant s ar e a s viewe d fro m tti e street , facin g propert y 

# ENTERE D OLS # 3S41 1 Dat e Excavated : 9/14/0 8 

### NO V 27^00 6 Dat e USEP ASigne d Off : 1/13/0 9 Are a Sodde d 227 5 s q f t



### Legen d Concret e Dri p Zon e Excavate d Quadrant s Excavate d Are a replace d wit h So d' ' Are areplace dwit h Are aleft bar e Rock/Mulc h 

### Contrac t # : EP-R7-07-0 5 Coasta l Environmenta l Grou p Inc .

# 3541 1

X Exterio rPain t Nort h Arro w 

### Omah a Lea d Sit e Owne rName : COLORAD O CLASSI C PRO P 

### • Goo d Sit e Sketc h Address : 4764 N 2 4 SI
_ 

### • Poo r Phone : H W 0 * No t pain t -f r Lea d Sampl e Sample s Collecte d Sampl e Numbe r LA B Concentratio n Collecte d Firm : /RSi-i l Ps l AT " RYASCPXA-3541 1 F l 

### Z i l pp m 

# 0 ' 

# ta Date : 11 - is-ot ^ RYBSCPXA-3541 1 F 2 

### J 8 pp m 

# 0 ^ D Time : | 0 "S o aTv^ RYCSCPXA-3541 1 B 1 

### _S3_l____pp m 

# [ T D Sample s Analyze d RYDSCPXA-3541 1 8 2 i H ^ pp m 

## D RDZSCPX Aaeon—D ^ ^ pp m 

# u D XR F Uni t JoeyBook : 

# n- ^ RGZCCPX A3541 1 G Z
~ pp m 

## D D Dat e J2 ' i2'OC s RPZOCPX A3541 1 Pi
. "~ pp m 

## D D Time : Arr , Staff : f^-it ^ Numbe ro f Sample s = ; ^ Legend : F l = Fron t Left , F 2 = Fron t Right , B l = Bac k Left , B 2 = Bac k Righ t D Z = Dri p Zone , G Z = Garden , P Z = Play Al l quadrant s ar e a s viewe d fro m tti e street , facin g propert y


## S , 

# 3rs ^ Lsy^ . 

# ^ps ~

. _ 3 

# I

# 3541 1 Exterio rPain t Nortl i Arro w 

### Omah a Lea d Sit e Owne rName : COLORAD O CLASSI C PRO P • Goo d 

### Sit e Sketc h Address : 476 4 N^2 4 S T • Poo r Phone: » W : 0 * No t paint Sampl e Numbe r Lea d Sampl e Sample s Collecte d LA B Concentratio n Collecte d Firm : /\s\ri \ ps i AJ ~ RYASCPXA-3541 1 F 1 

# :2_ L pp m 

# 0 ' D Date : n - I S - O 4> RYBSCPXA-3541 1 F 2 

## JL 8 pp m 

# D Time : ; o :3> o Qrr N RYCSCPXA-3541 1 B l pp m 

# D 

# 3 1 Sample s Analyze d RYDSCPXA-3541 1 B 2 1 H 6 pp m 

# D RDZSCPX A3611 1 Q ^ -~ pp m 

# D D XR F Unit : J00~ 7 Book: / 7 ^ RCZSCPX A3541 1 G Z ~" pp m 

# D D Date ; /2-/ 2 ' OC D f^PZCCPX A3641 1 P Z ~ pp m 

# D D Time : Anr , Staff : /^<u y Numbe ro f Sample s = , ^ I j — Legend : F l = Fron t Left , F 2 = Fron t Right , B l = Bac k Left , B 2 = Bac k Righ t D Z = Dri p Zone , G Z = Garden , P Z = Pla y Al l quadrant s ar e a s viewe d fro m tti e street , facin g propert y 

# 1

X

o O

Re v4 04614 1 0U 3 

## • _i-.U.i^'^ .-.. • ST_-_•.-_;-£3?t^|wl

# 3541 1 Exterio rPain t Nortt i Arro w Omah a Lea d Sit e Owne rName : COLORAD O CLASSI C PRO P • Goo d Sit e Sketc h Address : 476 4 N 2 4 S T • Poo r Phone : Jj ; W : 0 * No t paint Sampl e Numbe r Lea d Sampl e Sample s Collecte d LA B Concentratio n Collecte d Firm : As^n \ Q'~>\f\ T RYASCPXA-3541 1 F 1 "^ 1 pp m 

# 0 ' D Date : ll - \S - QCr ^ 

# 0 " RYBSCPXA-3541 1 F 2 

## J S pp m 

# D Time : ; o •.3> o ^TY^ RYCSCPXA-3541 1 B l 

## 83 1 pp m 

# [ T 

# n Sample s Analyze d RYDSCPXA-3541 1 B2 I M g pp m 

# D RDZSCPX A 3641 1 B £ ~ pp m 

# n XR F Unit : /AD" 7 Book:/7 ^ 

# D RGZCCPX A3541 1 -G Z • - pp m 

# n D Date : 72-/ 2 ' t^6 > RPZCCPX A3641 1 -P Z " " pp m 

## D Time : Arr- , 

# n Staff : /t^<i ^ Numbe ro f Sample s = : ^ Legend : F l = Fron t Left , F 2 = Fron t Right , B 1 = Bac k Left , B 2 = Bac k Righ t D Z = Dri p Zone , G Z • Garden , PZ = Pla y Al l quadrant s ar e a s viewed fro m th e street , facin g propert y 

# ENTEEE D

8 3 

# li.5 . Bi ^ N

J 

### Z M 

# -t r

^ F t 

## F2 . 

# IXX .IB .

-L . VJdlK ^

046141012 3 Re

v 4 

## .U . 2.4.. . ST .^'^•**'> ' COASTA L ^'^ l •-^It!' ' HtVinONHlHTA l ^*0 ^ C • O U p . IN C 

## Consen t Fo rAcces s T o Propert y RIGH TO F ENTR YT O PREMISE S 

### Granto r(th e propertyowner) consent s t o an d authorize s th e Unite d State s Environmenta l Protectio n Agenc y(EPA ) o rit s authorize d representatives , collectivel y th e Grantee , t o ente ran d perfor m certai n environmenta l respons e activitie s upo n th e followin g describe d premises : _. . 

# ,^1 1 Owner' s Name : Daytim e Phone :



## CWxpwVUi ^ KK^Mrvf s Addres s o f Propert y covere d b ythi s Agreement : 

# ^-\ M ua ns v PURPOS E O F RESPONS E ACTIVITIE S 

### Th e EP Ai s requestin g acces s t o collect soi l sample s an d remov e soi l tha t contain s elevate d concentration s o f lea d an d ma ypos e a healt h hazard
. Th e area(s ) wil l b e excavate d t o remov e contaminate d soil
. Th e remove d contaminate d soi l wil l b e replace d wit h clea n material s an d th e are a wil l b e restore d t o it s origina l condition
. Thi s wor k i s bein g performe d unde rth e Omah a Lea d Superfun d Sit e remediatio n program . Arepresentativ e o f Coasta l Environmenta l Group , contracte d byUSEPA , wil l contact th e Granto rin-perso n t o discus s th e wor k t o b e perfonned , th e Granto rwil l hav e a n opportunityt o revie wan d approv e th e planne d soi l removal , an d restoratio n wor k befor e i t begins
. Onc e th e wor k i s finished , th e Granto rwil l b e aske d t o revie wth e wor k an d confir m tha t i t i s complet e an d meet s wit h th e Grantor' s approval
. Upo n completion , th e Granto rwil l receiv e writte n documentatio n fro m EPAtha t th e property ha s bee n remediated
. ENVIRONMENTA L RESPONS E ACTION S 

### Bysignin g thi s Acces s Agreement , th e Granto ri s grantin g th e EPA , it s employees , contractors an d subcontractors th e right t o ente rth e property , at al l reasonabl e time s an d wit h prio rnotice , fo rth e sol e purpos e o f performin g th e work
. Thi s acces s shal l remai n i n effect unti l th e wor k ha s bee n satisfactoril ycompleted
. Th e Granto rals o agree s to :
Pag e 1 o f 2

# DRemot eID ; Rpag eo f

COASTA L



### •Remov e obstruction s includin g boats , trailers , vehicles , playscap e items , woo d piles , do g houses , etc ; • Remov e flowe rbulb s o rplant s tha t th e Granto ro rth e Grantor' s tenant ma ywis h t o save ; • Wate ran d maintai n replacemen t vegetation , includin g fertilize rapplication , a s necessarysubsequen t t o a n Initia l waterin g perio d b yEPA ; • Abid e b yhealt h an d safet yguidanc e provide d b yEPA ; • I f th e propert yi s rented , assis t EP Ai n obtainin g tenan t approva l fo racces s t o th e propert yt o perfor m th e woiit
. • Allo wvideotapin g and/o rphotographin g o f th e property . AGREEMEN TNO TT O INTERFER E 

### Th e Granto ragree s no t t o interfer e o rtampe rwit h an yofth e wor k activities , o rwit h an y o f th e wor k done , o rwit h th e equipmen t use d o n hi s property , o rt o undertak e an y action s regardin g th e us e o f sai d propert ywhic h woul d ten d t o endange rth e healt h o r welfar e o f th e Grantee s o rth e environment , o rt o allo wother s t o us e th e propert yi n suc h a manner . Shoul d yo u hav e an yquestion s abou t thi s program , pleas e contac t Coasta l Environmenta i Group , a t (712 ) 352-018 8

- ^ j ^ I gran t acces s t o mypropertie s • I d o no t gran t access t o m ypropertie s


# m M fy^ ^ Signatur e / Dat e Signatur eDat e
GI woul d lik e t o b e presen t durin g an ysamplin g tha t i s required
.COASTA L aM o u r - < M c 

## Restoratio n Agreemen t The purpos e ofthi s agreement is t o provid e ainutua l agreement a s to condition s ofth e propert y prior to remediatio nactivities . Thi s will als o serv e a s documentatio nfo r th e purpos e o f assurin g tha t restoratio n activitie s ar e completedt o the satisfactio nof the propert y owne r an dthe UnitedState s Environmenta l Protectio nAgenc y (EPA) . Propert y ID:-O^U U Propert y Address : ^^(p^ ^ \ ^ Q^^H i S^
- 

## KKxWt S Phone:(^^Y<^\U ^ 'AlnU V O

nthe attacheddiagram(s ) indicat e area(s ) t o excavatedan ddept hof excavation , locationo f all know n utilities , subsurface features , surface structure s an dlandscaping features , acces s location(s ) t o be use db y contractor , an dthe directiono f North . Indicat e distances , depths , materia l types , etc . Indicat e digita l photo s b

y referencing the photo-lo g numbe r wit ha narrow indicating directionof view . Item s T o B e Remove d B yOwne rBefor e Star t O f Remediation : (Us e additiona l sheet s a s necessary ) Th e removal , storage , disposal , and/o rretur n o f thes e item s i s th e Owner' s responsibility
. Item :

## M^AiP . \mi{^< : D4hpru)iR e rvsh^/lw^ndhp y Ite m Item : Item : Item : Item : Item : Item : Pag e 1 of
.< ^ ^ COASTA L f M VI«ONt« t MTA L O « O U P
. IM C 

### Item s T o B e Remove d B yContracto rDurin g Remediatio n An d No t Replace d (Us e additiona l sheet s a s necessary ) Item : 

## l\f]i j ^mnnl l fkyiH/debri s Item : Item : Item : Item : Item : Item : Item : Item : Item : Item : Item : Item : Item : Kem :

Pag e 2 of
.

### ( ^ C O AS T AL • MVtMONVttNTA L C « O U rIM C 

### Item s T o B e Remove d ByContracto rDurin g Remediatio n An d Replace d (Us e additiona l sheet s a s necessary ) Item : 

# ftl Item : 

# U Item : Item : Kem : Item : Item : Item : Item : Item : Item : Item : Item : Item : Item :

Pag e 3 of
.-mCOASTA L 

### Landscap e Inventory (Us e additiona l sheet s a s necessary ) 

## Ite m

Pre-existin g propert y area , tha t will b e excavated , tha t i s covere dwit hgrass .

Number of tree s > 2 inch trun k

diameter

Number o f tree s <= 2 inch trunk diameter

Number o f Sprinkler Zones , Contro l Valves , Timers , Heads , etc . Attachasketchof th e sprinkler layout .
Number o f an dsize o f eachgarden / flowe r be d area . Attac hasketchof relativ e size s an dlocations . 

## Quantit y Unit Condition/Type/Specie s 

# t) V Squar e fee t 

# V Eac h - .



### ^\ ^ Each



# < 5 Eac h

^ Eac h Squar e Feet

Pag e 4 of
.COASTA L CNvmONHftNTA t c» o u rIM C 

### Ite m Agree dupo nvalu e of plan t material s no t to b e renlace dbv contractor . Note thi s valu e will b e use dto issu e aplan t vouche r to th e propert y owner . Agree duponlis t o f plant material s tha t will b e replace db y contractor . B e ver y specifi c an ddetailed . Include asketcho f wer e eachplant will b e placed b

y th e contractor . Agree duponare aof propert y to b e replace d wit hgras s sod . Include asketcho f th e area(s ) to be replace dwit h gras s sod .
Are ao f Cit y o r Count y propert y to b e landscape d per thei r requirements . Include asketcho f th e aie a(s )

Easement Area , t o b e excavate d 

### Quantit y Urii t Condition/Type/Specie s

$ 

# 4

i Eac h


# <b\ S F


# T o b e dek.Y"VY\\r\ft l
S F


# Vendin g too\Vs S F

Pag e 5 of
.

# D Remot eID : Rpag eo f

; O A CT A K m * t t r . I M« . 

### Addttiona l ComnMrrts / Instnictlotis :

HjiF^ O Chec k th e bo x i f Owner doe s no t warit CE Gt o documen t inieiio r fiiurKlalio nwall s an dposs b pre-existin g damage . By checkh g thi s bo x CE Gi s rxit responsitile for an y damag e don e t o ti e interior o

f house , including fDundatio ncrack s o r fissures.

. ^ ^ • I apree G I d o Bo t agre e



## as L Owner' s Signttur e Dat e ContFutor' s Sqrnater c Dat e Pag e 6 O f

### BVID # Af:)Q U XR F PROPERT Y SAMPL E SHEE T Dat e 

## ^-\a-o ^ Addres s A-1^. ^

W-> • cDUl ^ S.V
. Projec t Omah a lead F P 2n a yea roptio n 

### Sampl e tim e 6'-a. Q am/p m XR F ID # 

## P^CP R sampl e lengt h 3 0 se c

Shot # j8iL o y>r61 1 c^"> S

Averag e Readin g :94^^^^^>?. ^ e ^ o?,R,3fti:^A & Dept h tSftl-l-i^dto^ M Sampl e are a .^" ^ \ ,^?> T
. ^ftj i .Q^
. n Averag e Sho t # Readin g Sampl e are a Dept h

Shot # Readin g Sampl e are a Shot # Readin g Sampl e are a Dept h Dept h 

### Averag e Averag e

Shot # Readin g Sampl e are a Shot * Readin g Sampl e are a Dept h Dept h 

### Averag e Averag e
RETES TAREA S Shot # 

# 4

iSza .

QLU
. 

### ^BI Q 

### 3B-lg > Readin g ^^.^L-CO-ft \ ^f? l o5t-^^.-?f( , ^^i-M\^>-^- ^ 

### fe^-..F>li35--vo Sampl e are a 

# •& 1 Dept h 

## la . Shot # Readin g Sampl e are a Dept h 

### Averag e X^ \ 7^ t ^?^.^XG Averag e la b sampl e # La b resul t Sampl e are a XR F Avg
. 

### Signature
. 

# ?^A^M ^ Prin t g.O»^^^tiQ^ ^ OAJ^WQ A

# Therm o SCIENTIFI C Therm o Fishe rScientifi c 90 0 Middlese xTurnpik e Billerica , M A0182 1

XL3t-3208 9 Readin g N o Mod e Tim e Duratio n Sequenc e Flag s BVI D # ADDRES S QUAD/ZON E INSPECTO R DEPT H SAMPL E TYP E NOT E
pp m P b 334.49 6 Supervise d By : 

## Certificat e o f Verificatio n

387 0 SOI L 2008-09-1 4 08:3 2 30.5 5 Fina l 3541 1 476 4 N 2 4 s t B l lope z 6 RETES T

± Erro r ± 22.81 0

# Therm o SCIENTIFI C Therm o Fishe rScientifi c 90 0 Middlese xTurnpik e Billerica , M A0182 1

XL3t-3208 9 Readin g N o Mod e Tim e Duratio n Sequenc e Flag s BVI D # ADDRES S QUAD/ZON E INSPECTO R DEPT H SAMPL E PT'P E NOT E
pp m P b 361.03 4 Supervise d By : 

## Certificat e o f Verificatio n

387 1 SOI L 2008-09-1 4 08:3 3 30.9 0 Fina l 3541 1 476 4 N 2 4 s t B l lope z 6 RETES T

±Erro r ±23.75 9

# Therm o SCIENTIFI C Therm o Fishe rScientifi c 90 0 Middlese xTurnpik e Billerica , M A0182 1

XL3t-3208 9 Readin g N o Mod e Tim e Duratio n Sequenc e Flag s BVI D # ADDRES S QUAD/ZON E INSPECTO R DEPT H SAMPL E TYP E NOT E
pp m P b 384.04 0 Supervise d By : 

## Certificat e o f Verificatio n

387 2 SOI L 2008-09-1 4 08:3 4 30.3 7 Fina l 3541 1 476 4 N 2 4 s t B l lope z 6 RETES T

± Erro r ± 24.52 7

# Therm o SCIENTIFI C Therm o Fishe rScientifi c 90 0 Middlese xTurnpik e Billerica , M A0182 1

XL3t-3208 9 Readin g N o Mod e Tim e Duratio n Sequenc e Flag s BVI D # ADDRES S QUAD/ZON E INSPECTO R DEPT H SAMPL E ryp E NOT E
pp m P b 325.81 2 Supervise d By : 

## Certificat e o f Verificatio n

387 3 SOI L 2008-09-1 4 08:3 4 30.2 5 Fina l 3541 1 476 4 N 2 4 s t B l lope z 6 RETES T

± Erro r ± 22.71 8

# Therm o SCIENTIFI C Therm o Fishe rScientifi c 90 0 Middlese xTurnpik e Billerica , M A0182 1

XL3t-3208 9 Readin g N o Mod e Tim e Duratio n Sequenc e Flag s AVERAG E ADDRES S QUAD/ZON E INSPECTO R DEPT H SAMPL E TYP E NOT E 

## Certificat e o f Verificatio n

387 4 SOI L 2008-09-1 4 08:3 4 122.0 7 Fina l I Av g o f 3870-387 3

476 4 N 2 4 s t lope z 

# f 6 ^RETEST J

pp m ± Erro r P b 351.34 5 ± 23.45 3 Supervise d By :

# Therm o SCIENTIFI C Therm o Fishe rScientifi c 90 0 Middlese xTurnpik e Billerica , M A0182 1

XL3t-3208 9 Readin g N o Mod e Tim e Duratio n Sequenc e Flag s BVI D # ADDRES S QUAD/ZON E INSPECTO R DEPT H SAMPL E PT'P E NOT E
pp m P b 227.19 8 Supervise d By : 

## Certificat e o f Verificatio n

387 5 SOI L 2008-09-1 4 08:3 6 30.6 1 Fina l 3541 1 476 4 N 2 4 s t easemen t lope z 1 CLEARANC E

± Erro r ± 19.60 6

# Therm o SCIENTIFI C Therm o Fishe rScientifi c 90 0 Middlese xTurnpik e Billerica , M A0182 1

XL3t-3208 9 Readin g N o Mod e Tim e Duratio n Sequenc e Flag s BVI D # ADDRES S QUAD/ZON E INSPECTO R DEPT H SAMPL E TYP E NOT E
pp m P b 245.86 1 Supervise d By : 

## Certificat e o f Verificatio n

387 6 SOI L 2008-09-1 4 08:3 7 30.5 2 Fina l 3541 1 476 4 N 2 4 s t easemen t lope z 1 CLEARANC E

± Erro r ± 20.34 6

# Therm o SCIENTIFI C Therm o Fishe rScientifi c 90 0 Middlese xTurnpik e Billerica , M A0182 1

XL3t-3208 9 Readin g N o Mod e Tim e Duratio n Sequenc e Flag s BVI D # ADDRES S QUAD/ZON E INSPECTO R DEPT H SAMPL E TYP E NOT E
pp m P b 238.28 2 Supervise d By : 

## Certificat e o f Verificatio n

387 7 SOI L 2008-09-1 4 08:3 7 30.6 1 Fina l 3541 1 476 4 N 2 4 s t easemen t lope z 1 CLEARANC E

± Erro r ± 20.39 5

# Therm o SCIENTIFI C Therm o Fishe rScientifi c 90 0 Middlese xTurnpik e Billerica , M A0182 1 

## Certificat e o f Verificatio n XL3t-3208 9 Readin g N o 387 8 Mod e SOI L Tim e 2008-09-1 4 08:3 8 Duratio n 30.4 3 Sequenc e Fina l Flag s BVI D # 3541 1 ADDRES S 476 4 N 2 4 s t QUAD/ZON E easemen t INSPECTO R lope z DEPT H 1 SAMPL E TYP E CLEARANC E NOT E
pp m ±Erro r P b 237.77 3 ±20.33 5 Supervise d By :

# Therm o SCIENTIFI C Therm o Fishe rScientifi c 90 0 Middlese xTurnpik e Billerica , M A0182 1

XL3t-3208 9 Readin g N o Mod e Tim e Duratio n Sequenc e Flag s AVERAG E ADDRES S QUAD/ZON E INSPECTO R DEPT H SAMPL E TYP E NOT E 

## Certificat e o fVerificatio n

387 9 SOI L 2008-09-1 4 08:3 8 122.1 7 Fina l I Av g o f3875-387 8

476 4 N 2 4 s t ~ ; / easement ^

lope z ^ 1

CLEARANC E

pp m ± Erro r P b 237.27 9 ± 20.17 1 Supervise d By :

### Omah a Lea d Site—Fixe d Pric e EP-R7-07-0 5 Coasta l Environmenta l Grou p Inc
. www.coastalhazmat.co m COASTA L ENVIRONMENTA L C R O U r, INC
. 

# EXECUTIV ESUMMARY : BVI D #3541 1 - (476 4 N2 4 ST )

X 

# N o Issue s o r Concern s I I Issues/Concern s Detai l Explanation: N O ISSUE S PENDING .

# .^EP A EP A Propert > Clos e Ou t For m Prop«n ytt : r¥S A\ \ Propert y Address : 4~|(PA.\V- ^ ,^0^^^ . Dale/Tlroc : Owner' s Name : OKf^^^A^lL,r ^ _KA..-H ^ Quad s Eicavatfd : "^\ Contracto rGrou p Oi2"~^-^^c x^ 'g^QvArPTviMjtjrvtu ^ Excavatio nGenera l V l\C A U' X L o T ' Ye s N o 1 I f necessary , were th e correc l quadram(s ) excavate dandreslored? ^ 2 If necessa-y , were th e correc t area s ofdri p zone excavate dandrestored' ' # Gradin g So d an d Vcgctatio p Ye s N o I Doe s the gradin g arown dlh > [ nliiiii ir r of th i houi c i nexcavate darea s generall y slop e awa y 

## v / fromtb e house ? 2 . Ha s so dbee nlai di r all area s tha t were excavated ? 

## X 3 . Doe s the sodappear to b e generall y healthy an dgrowing' ' (Onl y evaluate i f inspecte da t a3 0 u/^ day lim e period ) 4 Are soddedarea s generall y firman devenl y graded ? 

# y 5 Ar t the joint s betwee nth e so dstrip s generall y tight ? (Onl y evaluat e ifinspecie da i a3 0 da y < / tim e period ) 6 Wa s th e propert y grade dsuchtha t water will not poo l o nthe propertv ' c ^ 7 Wa s damag e t o landscapin g o r plan t material s avoided ? c ^ Galet , Fence s an d RcUinlD £ Wall s > e s N o 1 D o gate s ope n an d clos e freely? (Ifapplicable ) 2 Wer e al l gate s o rfence s take n dow n durin g restoralio n aciiviiie s reinstalled ? (I f ap p icable ) W L 

### /l/A ­ 3
. Wa s dam«g e t o gate s o rfence s avoided ? (Ifapplicable ) 4
. Wa s damig e l o relamin g wall s avoided ? (Ifapplicable ) Foun d • tlon , Sidio Kan d Guller s Ye s N o 1
. Wa s damag e t o th e sidin g o rtri m avoided ? ' 2
. Wa s damag e l o th e foundatio n avoided ? 

### [•D T 

# </ A 3 Wa s damag e 1 0 window s avoided' ' Mjti!,'^^ ^ 4 , Wa s damag e t o window s o rdoo rscreen s avoided ^ / 5 Wa s damag e l o downspout s o rdownspou l extension s avoided ? / Sidewalk s an dDriveway s (Concrelt ) Ye s N o Wa s damag e lo driveway surface s avoided' ' 2 Wa s damag e to vAalkwa y surface s avoided '

## O •ner s commeots :

Inspectio nnotes :

Removal an dresloraiio nactivate s complel e includin g the 30-da y so dwarrant y EP A Reoresentaliv e Dale :

## DRHttot eIDiRpag e

Propert yCompletio n Agreemen t Dii s agrconeii i dtwrnmem s th e compknio ncifrcancdiii l activilie s perlbnnec l o nmy properl y M y sigiKiiure will dcsignni e Ihat I « miiaii«li« dwil hth e re-Mofiiiio no f m

y property , am t ilml ii( i item s ar e i nqucstidivi . HOW . nr H

i an y lin w in(li e (inure , excqj l ihos e jlem.< i lisle dbeiow , i f >tny . Piop«i-t y II) ; 3 5~Y7 / " ' ^ Owner : ZXWc^_f f *>\C** 7 M^Jjt ' S

—_ 

# '•'"" " pgjj^/ /

ni l ^estoralloi ) Kem s I n QuMtion : Item : Ite m Item : Item : Ite m Additiona l Commanls :

J 5 I afT Kminr>(i«f l i> camplclcd , Clle^p t u IM(« I U I 'l o "' K•(!>••< • r<«H>riill»i i h csmplclrr f

Owner' s Sicnnliir c/ Dni cTunlriirtur'i i .Siuiiatiir rOal c